Apologies were received from Cllr PE Crockett and Cllr RL Mayo.

To receive details any details of members nominated to attend the meeting in place of a member of the committee.

Cllr ACR Chappell attended as a substitute for Councillor PE Crockett.

To receive any declarations of interest by members in respect of items on the agenda.

There were no declarations of interest.

To receive questions from members of the public.

Deadline for receipt of questions is 5pm on Friday 18 August 2017.

Accepted questions will be published as a supplement prior the meeting.

There were no questions from members of the public.

To receive questions from councillors.

Deadline for receipt of questions is 5pm on Friday 18 August 2017.

Accepted questions will be published as a supplement prior the meeting.

There were no questions from councillors.

To consider the committee’s work programme for the 2017-18 municipal year.

The chairman outlined the committee’s work programme which was based on two scrutiny work programme development sessions attended by members in June 2017. 

It was acknowledged that the items listed for scrutiny were proposals and that the work programme would be reviewed regularly and adjusted as necessary during the year to ensure priority items were covered. 

RESOLVED

That the proposed work programme and committee schedule be approved.

To review the quality and sustainability of  services commissioned by the Herefordshire Clinical Commissioning Group (CCG) from Wye Valley NHS Trust (WVT) on behalf of the population of Herefordshire.

The accountable officer, Herefordshire Clinical Commissioning Group (CCG) and the manging director, Wye Valley NHS Trust (WVT) presented the slides (appendix a).  A number of key points were highlighted:

•      Wye Valley NHS Trust was the major health service provider commissioned through a contract of £118million funded through the Department of Health. The Trust received additional income from out of county patients, for example Powys, contributing some 20% of WVT income.

•      WVT had been lifted out of special measures by the Care Quality Commission in 2016 and was now rated as “requires improvement”.  A new leadership team was making a difference to performance along with other factors including One Herefordshire, with organisations working together as part of the wider health and social care family. WVT had identified clinical and organisational priorities for 2017/18 to help sustain improved performance.

•       The financial context of WVT was not unique, as it was not unusual for small rural hospitals to have financial challenges because of how the national funding formula worked. However, there was a cost improvement programme in place for 2017-18 that was designed to reduce the deficit to between £15m and £20m.  The sustainability and transformation plan was designed to support efficiencies in service provision as a contributing factor.

•    The most significant performance targets reflected local needs and concerns. In particular:

o   the CCG and WVT had created a plan that had enabled additional funding to be secured to meet the national standard requirement for 92% of patients to be seen within 18 weeks of referral

o   There was work to do around continued improvement in A&E performance. However, it was noted that the national standard was met in Warwick and the new leadership arrangements, with links to South Warwickshire Foundation Trust, would provide access to good practice approaches to make a difference in Hereford

o   Cancer services were improving and all standards had been achieved in May

o   Steps were being taken to ensure that delayed transfers of care were improving and to work towards a model of ensuring people are supported to leave hospital with the right care at home.

•    The future performance of WVT would be supported through the contract with the CCG, and ensuring this worked in the best interest of population. There was increasing opportunity with other NHS providers and the voluntary and community sector working together to support this.

During the presentation members raised a number of questions and comments, with the following responses offered by officers:

In answer to a request for more detailed information on how money is spent, it was explained that it would be possible to provide a breakdown in the portfolio of contracts, although it should be noted that much of the income was driven by national arrangements such as the GP contract and so there was little discretion around price of services. 

In terms of out of county patients and particularly in relation to Powys services, there was a good relationship and there was a  ...  view the full minutes text for item 7.

The purpose of this report is to provide the committee with information relating to the intentions of Herefordshire Clinical Commissioning Group to undertake a county-wide public engagement programme relating to community health provision. 

The director of operations, Herefordshire Clinical Commissioning Group, presented the slides (appendix a), making the following key points:

•      The intended approach to engagement was informed by feedback from engagement work carried out by Healthwatch.

•      The vision was to empower patients to access the right care in the right place at the right time. This was represented in diagrammatic form as a blue print model which would be a talking point during engagement with communities. The blue print model was designed to show how support should begin within communities, around the person, with short-term specialist services reaching in.  It sought to ensure all services used the same language and shifted to an integrated approach.

•      The scope for engagement was wide, with top level strategic engagement and primary care working together to ensure that services were appropriate for managing both physical and mental health care needs. Engagement processes differed for urban and rural areas, with differing priorities and solutions, so the intention was to focus on localities.  

•      It was recognised that the distinction between engagement and consultation was not clear to everyone, so this had been explained in presentations. However, the patient story was the key and the critical point was for people to be able to tell the CCG about their experiences and whether they are getting access to the right support. Some sessions included one to one conversations to talk about specific issues and other approaches were more collective.

•      A key emerging theme was that people wanted help to remain as well as possible; the Healthwatch engagement was helping to draw out themes which were published online and would be used to feed back to communities and encourage further engagement.

•      There were various approaches to reaching communities including social media, although some aspects of this needed refining to ensure it was locality focused. 

•      A number of future events were arranged and details were on the ‘your conversation’ website. There was encouragement for communities and individuals to spread the word and members were asked to suggest other groups.  This approach was intended to identify some firm proposals for consultation and it was hoped that these would reflect back in the consultations so that people could recognise them.

Members made a number of observations and suggestions for developing the engagement during the presentation. These included:

•      That the pathways and support for people could be expanded and further examples made available so that people were better informed to know that they were receiving appropriate care and support for their condition. It was noted that not all people understood the various care pathways, such and what happens between seeing a GP and attending hospital and what support is available in the community, including the signposting role of WISH.

•      That the local radio such as BBC Hereford and Worcester would be an effective way of reaching people, such as through a phone-in session which would encourage engagement of people who did not use online social  ...  view the full minutes text for item 8.